支气管哮喘( 简称哮喘) 是由多种细胞包括气道的炎性细胞和结构细胞( 如嗜酸粒细胞、肥大细胞、T 淋巴细胞、中性粒细胞、平滑肌细胞、气道上皮细胞等) 和细胞组分参与的气道慢性炎症性疾病。近年来其患病率在全球范围内呈逐年增长趋势, 虽然90% ～95% 的哮喘患者应用吸入β2 激动剂和糖皮质激素治疗能够控制症状, 但停药后症状可能再次出现, 部分患者对激素治疗抵抗。随着对哮喘发病机制的深入认识, 探索了多种新的靶向治疗, 但目前还处于研发和临床试验过程中。现简要概述免疫调节剂相关的哮喘靶向治疗的作用机制、效应及与之相关的不良事件。
Objective To analyze the reason of tumor treatment-related premature ovarian failure, and to review the progress of ovarian functional reconstruction. Methods The l iterature about the effects of radiotherapy and chemotherapy on ovarian function and reconstruct ovarian function was reviewed, analysed and summarized. Results Radiotherapy and chemotherapy can both affect ovarian function. The ovarian function reconstruction included fresh ovarian transplantation and ovarian cryopreservation and transplantation. Frequent ovarian cryopreservation was procedure slow-freezing protocols and vitrification protocols. Some laboratory and animal models of ovarian function reconstruction have come to gratifying results. Conclusion Ovarian function reconstruction has a potential cl inical value and provides a promising future.
目的:评价奈达铂联合氟脲嘧啶/四氢叶酸治疗晚期复发耐药食管癌的疗效及不良反应。方法:30例晚期复发耐药食管癌均经病理学或细胞学确诊。奈达铂100mg/㎡,静脉滴注,第1天;氟脲嘧啶500mg/㎡,静脉滴注,维持6～8小时,第1～5天; 四氢叶酸200mg,静脉滴注,第1～5天,21天为一周期,连续用2周期后评价疗效及不良反应。结果:30例均完成2个周期以上化疗,共接受86周期化疗,全部病例均可评价疗效及不良反应。无CR病例,PR 13例(43.3%),SD 7例(23.3%),PD 10例(33.3%),有效率为43.3%,TTP 4.0月,MST8.3月。不良反应主要是骨髓抑制,恶心、呕吐,全组无IV度不良反应。结论:奈达铂联合氟脲嘧啶/四氢叶酸治疗晚期复发耐药食管癌有确切疗效,不良反应轻,耐受性好,值得临床进一步推广应用。
Objective To explore the feasibility， operation method， and clinical application value of transumbilical single-port laparoscopic cholecystectomy （TUSP-LC） in treatment for children patients with benign gallbladder diseases. Methods The clinical data of 64 patients with benign gallbladder diseases from June 2009 to June 2011 were analyzed retrospectively. The patients were divided into TUSP-LC group （n=41） and convention three-port LC （CTP-LC group， n=23）. The operative time， intraoperative blood loss， conversion to CTP-LC or laparotomy， operative complications， and hospital stay were recorded. The pains were registered at 3，6，12，24，48， and 72h postoperatively using visual analog scale （VAS）. The patients were given satisfaction questionnaires with surgery at 6 time points （1 week， 2 weeks， 1 month， 3 months， 6 months， 12 months） during a 12 months follow-up. Results A total of 64 pediatric LCs were performed successfully， no patients were converted to laparotomy. Except for one case of incision infection in the CTP-LC group 〔4.35%（1/23）〕 and one case of incision infection and one case of ecchymoma in the TUSP-LC group 〔4.88% （2/41）〕， no other complications such as bile duct injury， bile leakage， and incision hernia happened， the total complication rate was not significant difference in two groups （P＞0.05）. The operative time 〔（47.54±18.71） min versus（45.33±10.58） min〕， intraoperative blood loss 〔（18.56±13.34） ml versus （17.28±12.53） ml〕， and hospital stay 〔（1.67±0.36） d versus （1.81±0.38） d〕were not significant differences in two groups （P＞0.05）. The VAS score was not statisticly significant within 24h in two groups （P＞0.05）， but which in the TUSP-LC group was significantly lower than that in the CTP-LC group after 24h postoperatively （P＜0.05）. During a 12 months follow-up， the score of satisfaction in the TUSP-LC group was significantly higher than that in the CTP-LC group （P＜0.05）. Conclusions TUSP-LC is a safe and feasible method in the children patients with benign gallbladder diseases. It can be performed with the same technical exposure and outcomes as multi-port laparoscopy， with the added benefit of relieving postoperative pain and little no scarring.
【Abstract】ObjectiveTo investigate the relevant factors for fungal infection following pancreatoduodenectomy and offer the theoretical foundation for preventing the emergence of complications after operation． MethodsMedical records from 562 consecutive patients who underwent pancreatoduodenectomy in this hospital from 1995 to 2005 were retrospectively reviewed by using single factor and noncondition Logistic regression analyse. Results①Seventyeight patients (13.9%) developed invasive fungal infection. The most frequently isolated fungal were Candida albicans accounted for 67.0%， and followed by Candida glabrata, Candida papasilosis and Candida tropicalis and gastrointestinal tract was the most common infection site, followed by respiratory tract, abdominal cavity. ②Fungal infection occurred significantly more often in patients with the length of time in parenteral nutrition, antibiotic use or abdominal cavity complications. Conclusion The most common infection site and isolated fungal associated with pancreatoduodenectomy were gastrointestinal tract and Candida albicans. Abdominal cavity complications such as pancreatic fistula， biliary fistula and abdominal infection and extended use parenteral nutrition and antibiotic are the most important factors leading to invasive fungal infection after pancreatoduodenctomy. Eliminating the various risk factors will decrease the incidence of fungal infection.
Objective To investigate the application of risk assessment in the control of nosocomial infections in surgical departments of infectious disease hospitals so as to provide references for the regulation of prevention and control measures. Methods Nosocomial infection risks in surgical departments of infectious disease hospitals were identified by the method of brainstorming. Based on risk assessment and planning of American children's national medical center in Washington for epidemic and infectious diseases control, the matrix method was used for risk assessment. The three highest risks were controlled, and then we compared the incidence of nosocomial infections before and after the risk assessment. Results The major risk factors in surgical departments existed in the process of diagnosis and treatment. By matrix scoring, excluding high readiness items, we found that the top three risks were airborne diseases, prevention and nursing of hematogenous infections and air disinfection. Nosocomial infection rate in the surgical departments dropped to 2.03% after carrying out risk assessment and taking correspondent measures (χ2=5.480,P=0.019). Conclusion Evaluation of nosocomial infection risk in surgical departments of infectious disease hospitals can discover major potential risks and reduce the incidence of nosocomial infections, which can provide references for management and control of nosocomial infections.
ObjectiveTo systematically review the comprehensive evaluation methods applied to estimate the medical service performance based on diagnosis-related groups (DRGs) in China and to provide suggestions for the promotion of methods in further studies.MethodsLiterature published before May 2019 were searched in China National Knowledge Infrastructure, WanFang Data, CQVIP and PubMed for studies about DRGs-based comprehensive evaluation. After literature screening and information extracting by two reviewers independently, qualitative approaches were used to describe the application of DRGs-based comprehensive evaluation methods in the performance evaluation of medical services.ResultsA total of 24 articles were included in the systematic review. Different indexes were used to evaluate the medical service performance. Delphi Method, expert discussion, Saaty’s Method and some other means were applied to determine the weights of indexes in 8 articles. Rank-sum ratio method, Technique for Order Preference by Similarity to an Ideal Solution and synthetic index method were proposed for the comprehensive evaluation in 9, 7 and 9 articles, respectively; besides, analytic hierarchy process and combination evaluation were also used.ConclusionsBased on DRGs, the choose of indicators, weighting approaches, and calculation methods of comprehensive values vary richly in different studies. More attention should be paid to weight using and combination of comprehensive evaluation methods in further studies. Meanwhile, the quality of information source used for estimation and the rationality of results application are supposed to be emphasized.
目的 通过分析环境空气中二氧化硫与过敏原的关联性，探讨二氧化硫在评估过敏性疾患中的作用。 方法 收集2005年1月1日－2012年12月31日绵阳市4个监测点二氧化硫浓度，及2007年7月1日－2012年12月31日的过敏性疾病患者各种过敏原的阳性百分比，采用Pearson相关分析探讨二氧化硫浓度变化对过敏原的影响。 结果 2005年－2012年绵阳市二氧化硫年平均浓度分别为（0.060 ± 0.022）、（0.054 ± 0.018）、（0.046 ± 0.012）、（0.030 ± 0.020）、（0.026 ± 0.010）、（0.035 ± 0.012）、（0.036 ± 0.008）、（0.030 ± 0.009） mg/m3。淡水鱼组合（fs34），海鱼组合（fs33），羊肉（f88），黄豆（f14），花生（f13），狗上皮（e2）与二氧化硫的Pearson相关系数分别为：0.144、0.186、0.209、0.150、0153、0.197。检验P值分别为：0.019、0.002、0.001、0.015、0.013、0.001。按α=0.05标准认为与二氧化硫存在正相关关系。而其余的尘螨组合（ds1）、普通豚草（w1）、律草（u80）、树组合（ts20）、雷菌组合（ms1）、蟑螂（i6）、屋尘（h1）、牛肉（f27）、虾（f24）、蟹（f23）、牛奶（f2）、鸡蛋白（f1）、猫毛（e1）、艾蒿（w6），按α=0.05标准，不能认为与二氧化硫存在正相关关系。 结论 环境空气二氧化硫与淡水鱼、海鲜、羊肉、大豆、花生及狗皮屑具有明确的相关性，对树组合、普通豚草、艾蒿、尘螨组合、屋尘、猫毛、蟑螂、霉菌组合、律草、鸡蛋白、牛奶、牛肉、虾、蟹等无明确的相关性。
Objective To explore the possible anti-inflammatory mechanism of peroxisome proliferators-activated receptor（PPAR） gamma-agonists by investigating the effects of Rosiglitazone on the expression of phosphorylation of signal transducer and activator of transcription 6（p-STAT6） and the secretion of interleukin（IL）-4 in T-lymphocytes from patients with acute asthma.Methods Peripheral blood T-lymphocytes from 10 healthy volunteers（group A） and 10 patients with acute asthma were isolated，purificated and cultured.T-lymphocytes from the asthma patients were divided into a control group（group B） and a Rosiglitazone treated group（group C）.Rosiglitazone was added with a single dose of 10-4 mol/L at 0 hour of cultrue.After cultured for 48 hours，the concentration of IL-4 in supernatant of each groups were detected by ELISA.The express of p-STAT6 in the T-lymphocytes were determined by Western blot and immunohistochemical techniques.Results The levels of IL-4 were increased markedly in group B than those in group A and group C[（170.34±9.05）pg/mL vs（76.82±7.06）pg/mL and（123.59±8.70）pg/mL，both Plt;0.01]，and which in group C was significantly lower than group A（Plt;0.01）.The levels of p-STAT6 in T lymphocytes were increased markedly in group B than in group A and C[Western blot：（6.28±0.19 vs 3.07±0.18 and 4.12±0.16；immunohistochemistry：（36.58%±7.41）% vs（11.39±4.02）% and（23.92±5.8）%，all Plt;0.01），and which in group C were significantly higher than that in group B（both Plt;0.01）.There was a positive correlation between the level of p-STAT6 and IL-4（Plt;0.01）.Conclusion The levels of p-STAT6 and IL-4 in T-lymphocytes of patients with acute asthma were suppressed by Rosiglitazone in vitro.
【摘要】 目的 比较密度梯度离心法及全骨髓培养法分离培养内皮祖细胞的差异。方法 取4周雄性近交系C57BL/6J小鼠骨髓,分别使用密度梯度离心法及全骨髓培养法培养,观察细胞贴壁情况和细胞形态,并行DiIacLDL及FITCUEAI双染、vWF、eNOS及细胞表面标志检测。结果 密度梯度离心法培养细胞可形成典型铺路石样改变及形成血管样结构;而全骨髓培养法贴壁细胞形态多样,较多呈长梭形铺展生长,部分细胞呈类圆形及纺锤形。比较两种方法培养细胞摄取DiIacLDL、结合FITCUEAI双阳性率以及vWF、eNOS及细胞表面标志表达阳性率,差别均有统计学意义(Plt;005)。应用密度梯度离心法,随着培养时间延长,表达CD34、CD133及FLk1细胞逐渐增多(Plt;005)。结论 密度梯度离心法及全骨髓培养法在EGM2MV培养体系下均可培养出内皮祖细胞,但密度梯度离心法较全骨髓培养法培养的内皮祖细胞纯度高。